Dying of cancer, poker pro plans assisted death in Sacramento after one last ‘dance’ in Vegas

If all goes according to plan, Kevin Roster will win enough money this summer at the World Series of Poker in Las Vegas to support his son and donate a portion of his winnings to charity.

Then he’ll return to the Sacramento region to die. He hopes to pass away peacefully with help from a doctor and with loved ones at his side.

It’s a plan that’s taken him 2,800 miles across the country, cost him thousands of dollars and has him advocating for new assisted-suicide legislation in multiple states that he says would end needless suffering, without the need to hop state lines.

Roster, 36, is afflicted with a rare and hyper-aggressive form of cancer called sarcoma.

He called the discovery a “whoops procedure”: A doctor found a mass on the back of Roster’s thigh, he said in an interview with The Bee at his Rancho Cordova apartment before his trip. Doctors initially thought the lump was benign.

Instead, Roster has endured eight rounds of chemotherapy, nearly four dozen radiation treatments, the growth of a 20-pound tumor and three surgeries including amputation of his left leg – all since his December 2017 diagnosis, which he says was delayed significantly.

Roster believes everyone should have the legal right to end their suffering.

“At the end of the day, the only opinion that matters is the person who’s dying,” he said. “I’m not saying blow your family off, but ultimately we all should have this choice. ... I wanna die in control, not being left up to cancer to decide when I’m gonna go, how I’m gonna go, how painful.”

But he recognizes that it’s a controversial subject. Roster said people shouldn’t necessarily follow his footsteps and should make their own end-of-life decisions.

The native of Queens, New York, had spent much of the decade before the diagnosis living in New Jersey, running a successful collectibles business with his wife, raising his now-9-year-old son and playing poker semi-professionally.

A self-described entrepreneur, he said he’s lived a relatively full life for a 36-year-old. With his worsening prognosis, moving to California jumped quickly to the top of his bucket list.

On Aug. 1, New Jersey’s medical aid-in-dying law will take effect, making it the eighth state to allow terminally ill patients like Roster the right to obtain prescribed assisted-death drugs from a physician.

But Roster simply may not live that long. After his amputation in April and his latest CAT scan results May 20, doctors informed him he had weeks – not months – left to live.

So he and a caretaker made the cross-country move last week from Collingswood, New Jersey, to California, where assisted death became legal in 2016 and where Roster has already started the final phase of his life.

‘Intolerable pain and suffering’

Roster has been bound to an electric wheelchair since April, when his latest surgery – to remove a 20-pound tumor – required amputation of his entire left leg and hindquarter.

He says he doesn’t mind being wheelchair bound, all things considered, and that it’s not a factor in his decision to seek medical aid in dying.

But sarcoma’s progression is worse than just a lost limb.

Roster said he still thinks “life is beautiful.” But as the disease spreads rapidly toward his heart and lungs, he is increasingly faced with the prospect of “intolerable pain and suffering at the very end of life,” possibly gasping for air or choking on his own blood, as he wrote in an op-ed for Compassion & Choices, a nonprofit aid-in-dying advocacy group.

He said the worst thing he was experiencing as of Tuesday was “phantom pain,” aches and cramps coming from his nonexistent left leg.

Affecting only about 1 percent of adults with cancer, nearly 6,000 people a year die from sarcoma, according to the Sarcoma Foundation of America. Sarcoma is much more common in children, affecting about 20 percent of child cancer patients.

Struggle with the cancer contributed to Roster and his wife separating soon after the diagnosis, he said. They are now on amicable terms, with his wife taking care of their son and running the family business, Collectibles NJ, an internet resale and consignment company that specializes in estate services.

Roster has documented his recent poker journey and move to California in blog posts and a YouTube channel.

‘Life goals became my bucket list’

He says he wants to use his final days at the World Series of Poker in Las Vegas – where thousands of pro and amateur card players congregate each summer for dozens of tournaments ahead of the $10,000-entry main event – as a dual-front awareness campaign: on sarcoma, and on legalizing aid-in-dying.

Roster plans to wear a special T-shirt that he had made to educate on the rare form of cancer. The shirt includes a link to his website and several facts and statistics about sarcoma on the front and back. Among them: “Over 70% of Sarcomas are MISDIAGNOSED. The difference in early detection can be a matter of LIFE OR DEATH.”

“If you have any lump anywhere in your body that’s growing – arms, legs – get it biopsied,” he said. “Demand a biopsy. If they won’t cover it, pay out of pocket. I wish I would have.”

Roster also says he will donate about 10 percent of his poker profits in June and July to St. Jude Children’s Research Hospital. He chose St. Jude because the system does not bill patients directly.

Roster made it clear that he did not come to California specifically to die. There are states closer to New Jersey, like Vermont, where doctor-aided dying is also legal.

But living in Northern California was always a dream of his, and California’s laws “do fit my beliefs,” Roster said.

“My plan was always to franchise my business off and move west to California,” Roster said. “I’m not a tourist, I’m a resident of California. ... And then with the diagnosis, my list of life goals became my bucket list.”

Roster settled in the Sacramento suburbs, which he called a perfect fit: affordable, with proximity to several major cancer centers, he said. The cross-country move and related preparations cost Roster about $10,000, he said.

While he declined to name his doctor or the exact facility where he’ll receive end-of-life care, Roster says he is being treated through Sutter Health. He will also get help from hospice care in his final days, though he has not yet set a date for his death.

He moved into a Rancho Cordova apartment May 29; six days later, he was out the door, embarking on the nine-hour drive to Vegas.

Dying with dignity

Roster also hopes to spread his message about acceptance of aid-in-dying, currently legal in only seven states: California, Oregon, Colorado, Montana, Hawaii, Vermont and Washington state. It’s also permitted in D.C.

Eighteen other states have introduced aid-in-dying legislation this year, and it’s still being considered in 12 of them: Arizona, Delaware, Indiana, Iowa, Kansas, Maine, Massachusetts, Minnesota, New York, North Carolina, Rhode Island and Utah. The Maine Legislature on Tuesday voted to legalize assisted suicide; Democratic Gov. Janet Mills has 10 days from then to act on the bill, but has not yet indicated her position.

California’s End of Life Option Act went into effect June 9, 2016, allowing terminally ill adults to self-administer aid-in-dying drugs prescribed by a doctor.

The prescription itself is a compound of multiple different medications, including morphine and diazepam, according to Dr. Catherine Sonquist Forest, a board-certified family physician with UC San Francisco who mentors younger physicians through the California Healthcare Leadership Foundation.

Patients must be adults who are considered terminal, with six months or less to live, Forest explained. They must get oral permission from two different physicians, at least 14 days apart, to obtain the prescription.

The most well-known case of a terminally ill patient leaving their state to seek assisted death happened less than two years before the California law passed, when 29-year-old Brittany Maynard moved from Anaheim to die in accordance with Oregon’s “Death with Dignity Act,” which passed in 1994.

Roster’s case is likely the farthest any American has traveled to legally die with dignity, according to Compassion & Choices.

The California Department of Public Health keeps yearly data on all qualified assisted suicide participants. A total of 258 patients chose to use the process from June 9, 2016, through the end of that year: 111 died after ingesting the drugs, 21 died before they had the chance to use them, and the process extended into 2017 for the remainder.

In 2017, 632 patients started the process: 363 died via aid-in-dying drugs, 86 died without ingesting them, and the rest were still alive and awaiting the meds by the end of the year.

A May 2018 Gallup poll found that 72 percent of Americans supported right-to-die laws for patients with incurable diseases.

Still, doctor-assisted end of life is not without its critics, one of the reasons why Roster chose not to disclose the identity of his doctor or caretaker.

California’s End of Life Option Act passed in 2016 despite opposition and lobbying against it from the Catholic Church and from the disability rights community. Additionally, some oncologists opposed the law, noting that terminally ill patients can often outlive their diagnoses.

Other physicians, like UCSF’s Forest, strongly support assisted death.

“I came of age in medicine in the 1980s at the height of the AIDS era, where I saw firsthand the impact of prolonged dying,” she said. “It became very apparent to me that that was not the most compassionate way of caring for humans, where there were no medical treatments other than prolonging their death.”

Having practiced for close to 30 years, Forest said she was an “avid supporter” of the passage of the End of Life Option Act.

“I believe the issue (now) is familiarity and comfort with the procedure,” she said. “I do believe that, as it has been clear that Californians support aid in dying and have settled on how to do it, ... that it’s largely a logistical question of who and how and when. There’s more ease now (than in 2016).”

The End of Life Option Act was ruled unconstitutional in a California trial court May 2018, but reinstated in appeals court the following month. Plaintiffs urged the state Supreme Court to review the case, and the court denied that request this February, keeping the law in effect.

The California Medical Society’s official position on aid-in-dying was “opposed” before June 2015, when it was changed to “neutral.” Doctors are not required to offer assisted-death prescriptions, and many decline to do so. The American Academy of Family Physicians, which represents more than 150,000 doctors nationwide, has also shifted its official position to neutral.

Dreaming of a bracelet

Roster says he spent the early 2000s in New York’s underground poker scene and, before the federal government banned internet poker in 2009, he played as a sponsored pro online.

Money is secondary to the distinct honor of winning a gold World Series of Poker bracelet, a dream Roster has had his entire adult life. He has a tattoo of a poker hand – a pair of aces – on his right forearm.

A bracelet is awarded to the winner in each of the summer tournament series’ 89 events. Although about the top 15 percent in each event finish “in the money” and rake in a profit, and a final-table finish can bring paydays of six figures or more, only the outright winner in each tournament earns a bracelet, which is widely considered the game’s most prestigious accolade.

With almost every tournament in the series yielding well over 1,000 entrants, that’s no easy feat. Roster knows this.

“This is my last chance to dance so I’m putting my boogieing shoes on. I’m gonna go try to do it. Will the cards cooperate? I don’t know.”

Roster doesn’t know exactly how many events he’ll play at the tournament. He hopes to play at least five or six events. If health permits and he wins big early, he’ll try to play more, he said.

He started his quest Wednesday evening with Event No. 16, a buy-in of $1,500. Roster was eliminated in Day 1 of the three-day tournament – but there are multiple tournaments starting each day to give him another chance at a score.

By the end of Roster’s trip, he hopes to secure a sponsor that would buy him into the $10,000 main event in July, so that he could return to Vegas and play while continuing to raise awareness for his causes. Best case scenario, he says, is that he makes it onto ESPN’s coverage of the WSOP main event, where his shirt and message can be televised.

And if he wins a bracelet in any event he plays?

“Honestly, I’d probably wear it until I couldn’t anymore. And then I’d probably leave it to my son.”

Michael McGough anchors The Sacramento Bee’s breaking news reporting team, covering public safety and other local stories. A Sacramento native and lifelong capital resident, he interned at The Bee while attending Sacramento State, where he earned a degree in journalism.